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Provider Notice Issued 07/05/2022

Date:   July 5, 2022

To:      Community Mental Health Providers

Re:      Changes in Billing Policy for Integrated Assessment and Treatment Planning (IATP), Community Support, and Crisis Stabilization Services

________________________________________________________________________________________________________This notice informs providers of changes to the billing policy for Integrated Assessment and Treatment Planning (IATP), Community Support, and Crisis Stabilization services. This change applies to claims billed under both the Department's fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCO) plan programs. 

Reimbursement for IATP: Licensed Practitioner of the Healing Arts (LPHA) Review

Effective for dates of service on and after July 1, 2022, the Department is seeking approval from the federal Centers for Medicare & Medicaid Services (CMS) to reimburse providers for the time spent by an LPHA clinically reviewing and authorizing a customer's IATP when the IATP is completed by staff other than an LPHA (i.e., when the IATP is completed by a Mental Health Professional or a Qualified Mental Health Professional).  IATP: LPHA Review services are to be billed as follows:

 

Service NameProc CodeModifiersUnitsState Max
12On-SiteOff-Site
IATP: LPHA ReviewH2000SC 1/4 hr$ 31.81N/A

 

Providers must hold any applicable FFS claims for IATP: LPHA Review services until the Department announces, via provider notice, it is ready to receive claims. Claims submitted for IATP: LPHA Review services submitted before the Department indicates it is ready will be rejected. Providers must check with the applicable HCI MCO plan regarding the submission of claims for IATP: LPHA Review services delivered to HCI MCO enrolled customers.

Change in Units for Crisis Stabilization Services

Effective for dates of service on and after July 1, 2022, Crisis Stabilization services will be reimbursed in 15-minute increments rather than one-hour increments. Providers must adjust the units on claims for Crisis Stabilization services to reflect this change. 

The Department is also proposing updating the reimbursement rate for Crisis Stabilization services to $25.00 per 15-minute unit for services delivered on-site or off-site. The change in reimbursement is subject to approval from federal CMS. Providers do not need to hold FFS claims for Crisis Stabilization services for dates of service on and after July 1, 2022; however, providers will be required to adjust their claims following federal CMS approval of the proposed 7/1/2022 CBS Fee Schedule to receive the higher per unit reimbursement rate.

 

Service NameProc CodeModifiersUnits

Current State

Max

Proposed 7/1/22 State Max*
12On-SiteOff-SiteOn-SiteOff-Site
Crisis StabilizationT1019HN 1/4 hr$13.33$13.33$ 25.00$25.00

*Pending federal CMS approval

 

Billing for Community Support for Customers in a Residential Setting

Effective for dates of service on and after July 1, 2022, Community Mental Health Centers (CMHCs) billing for Community Support services delivered in a residential setting to customers on an individual basis are no longer required to utilize the modifier 'HK' when submitting claims for reimbursement. Claims for Community Support Individual services delivered in a residential setting are to be submitted consistent with the CBS fee schedule allowable HCPCS (H2015) and modifier (HM, HN, HO) combinations for Community Support services.

Policy questions regarding this notice may be directed to the Bureau of Behavioral Health via email at HFS.BHCompliance@illinois.gov. Billing questions regarding this notice may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at

877-782-5565 or the applicable managed care plan.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs

 


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